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Abstract

Introduction: A great emphasis exists on improving PCI outcomes and quality, but there are no data on the variation in hospitals' costs of PCI. As Payers move away from a fee-for-service model, most forms of bundled payments or gain-sharing, increasingly require hospitals to contain costs. Hospitals are at financial risk if costs exceed a specified budget. Our goal was to understand the variation in costs of PCI across hospitals, and the extent of the variation in PCI costs explained by hospitals, after controlling for patient characteristics.

Methods: We identified 230,410 patients undergoing PCI at 258 hospitals (performing ≥100 PCIs), from 2007-2010 from the Healthcare Cost and Utilization Project state inpatient database (SID) from California, Florida and New York. The SID includes 97% of all discharges regardless of payers, from these states. Costs of PCI were determined by applying hospital- and year-specific Cost-to-Charge Ratios to the total charges. Variation in costs of PCI across hospitals were examined by a hierarchical linear regression model with PCI costs as the dependent variable and hospital site as a random effect, adjusting for differences in prevalence of patient and demographic characteristics by hospital site.

Results: The mean cost of performing a PCI procedure was $17,543 ± $ 12767. We observed a large degree of variation in mean PCI costs across hospitals ranging from $5,823 to $38,532. Length of stay (LOS), was associated with incrementally higher PCI cost ($2,400, per day p<0.0001). After adjusting for LOS, PCI complications, and patient comorbidities, we observed a persistent 24% variation in PCI costs across hospitals. A significant interaction between hospital cost quintile and LOS (interaction P-value <0.001) was also observed, such that in the highest quintile hospital, PCI costs were higher by $1,277 per day LOS, despite adjusting for LOS and patient comorbidities and PCI complications.

Conclusions: PCI costs vary tremendously across hospitals. Approximately one quarter of the variation in PCI costs is explained by hospitals, despite controlling for differences in LOS, PCI complications and patient characteristics. The same LOS costs differently across different hospitals. There is an urgent need for hospitals to examine and reduce the variation in PCI costs.